Bacteriologic diagnostics and antibiotic management in German intensive care units: data from project SARI (Surveillance of Antibiotic Use and Bacterial Resistance in German Intensive Care Units)
Abstract number: 10.1111/j.1198-743X.2004.902_o202.x
To evaluate bacteriologic diagnostics and antibiotic management in intensive care units (ICUs) in Germany.
A questionnaire was sent to each of the 38 (3/2003) ICUs participating in project SARI, which was initiated in February 2002. Of these ICUs, 29 returned the questionnaire for analysis. The questionnaire contained questions on the following: implementation of guidelines concerning antibiotic treatment in ICUs, diagnostic procedures and empiric choice of antibiotics given for pneumonia, bloodstream infections, surgical site infections and other community acquired and nosocomial infections in ICUs.
19 ICUs use written guidelines on antibiotic management. Only 14 of 29 ICUs collect quantitative specimens for ventilator associated pneumonia, although recommended by national guidelines. Empiric antibiotic treatment differs considerably in ICUs, even for common infections. 29 ICUs use nine different first line treatment options for late onset ventilator-associated pneumonia. Only six ICUs favour a reasonable combination therapy to target P. aeruginosa and Acinetobacter sp. as important underlying pathogens. Resistance rates for P. aeruginosa (testing in accordance with DIN) are high in SARI-ICUs: 18.3% for ciprofloxacin, 26.1% for imipenem and 24.3% for piperacillin/tazobactam (cumulative data from 2/20006/2003). Regarding empiric central line associated blood stream infection, 26 ICUs use a total of 12 first line treatment options. 18 ICUs (69%) use glycopeptides alone or in combination, in spite of the fact that MRSA rates are low (<10%) in their ICU (n = 5).
Although national guidelines are available, considerable differences still exist in microbiologic diagnostics and empiric antibiotic treatment in ICUs in Germany. Guidelines for ICUs have proved to be a useful instrument for quality management and for the improvement of empiric antibiotic treatment and microbiologic diagnostics. However, discrepancies exist between the recommendations given by guidelines and actual medical practice in the ICU setting."
|Session name:||XXIst ISTH Congress|
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